Healthcare Provider Details

I. General information

NPI: 1518875756
Provider Name (Legal Business Name): RYLAN CHRISTOPHER SMITHLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 W SYCAMORE ST
KOKOMO IN
46901-5148
US

IV. Provider business mailing address

5116 S WEBSTER ST
KOKOMO IN
46902-4943
US

V. Phone/Fax

Practice location:
  • Phone: 111-111-1111
  • Fax:
Mailing address:
  • Phone: 765-243-5821
  • Fax: 765-243-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number4531-8124
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: